Method for delivering medication into an arterial wall for prevention of restenosis

ABSTRACT

A method for preventing a restenosis within a vessel wall requires a medicament be delivered at predetermined locations into the vessel wall and allowed to subsequently disperse in a predetermined pattern. To deliver the medicament, a catheter with an expanding member is advanced into the vasculature of a patient until the expanding member is located as desired. The expanding member is then expanded to force dispensers into the vessel wall to the proper depth. A medicament is then pumped through the dispensers to create a plurality of equally spaced, localized medicinal deliveries which subsequently disperse to medicate an annulus shaped volume within the vessel wall.

[0001] This application is a continuation-in-part of application Ser.No. 09/232,392, filed on Jan. 15, 1999, which is currently pending. Thecontents of application Ser. No. 09/232,392 are incorporated herein byreference.

FIELD OF THE INVENTION

[0002] The present invention pertains generally to a method for treatingthe vessel of a patient. More specifically, the present inventionpertains to a medical method for treating a vessel of a patient'scardiovascular system by injecting a fluid directly into the vesselwall. The present invention is particularly, but not exclusively, usefulfor preventing a restenosis by releasing a medicament at severalpredetermined locations within the vessel wall to circumferentiallydisperse the medicament in the vessel wall.

BACKGROUND OF THE INVENTION

[0003] Angioplasty is a widely used procedure for treating a stenosiswithin a body vessel such as a human artery. During an angioplastyprocedure, a medical catheter having an inflatable balloon attached to acatheter shaft is advanced within the lumen of the body vessel until theballoon is adjacent to the stenosis. Next, the balloon is inflatedcausing the stenosis to compress into the vessel wall and the lumen ofthe vessel to dilate.

[0004] Although the angioplasty procedure is generally successful indilating the lumen of the vessel and thereby allowing increased bloodflow through the vessel, often times a restenosis occurs soon after theangioplasty procedure. It is widely recognized that the bodies response(inflammation) to tissue damage that occurs during the angioplastyprocedure contributes to the restenosis. Several medicaments are knownto be efficacious in the prevention of a restenosis if properlydelivered near the site of the inflammation.

[0005] Heretofore, a number of devices have been suggested for use inconjunction with an angioplasty procedure to obviate a restenosis. Forexample, one such device utilizes a balloon to position a plurality ofapertures against the vessel wall near the stenosis. After positioningthe apertures, a medicament is released from the apertures, where themedicament contacts the endothelium layer of the vessel. Unfortunately,use of the aperture device generally results in an insufficient amountof medicament being delivered to the target area because a large portionof the released medicament does not penetrate the vessel wall, butrather, is washed away into the blood stream. Further, due to the toxicnature of some of the medicaments used in this procedure, the largeportion of medicament entering the bloodstream can cause adverse healtheffects to the patient.

[0006] Also heretofore, devices capable of penetrating the wall of avessel with a dispenser and releasing a medicament within the vesselwall have been disclosed. For example, U.S. Pat. No. 5,713,863, filed onJan. 11, 1996 and entitled “Catheter With Fluid Medication Dispensers”and which is assigned to the same assignee of the present invention,discloses such a device.

[0007] It is to be appreciated that the use of devices with expandingmembers and penetrating dispensers will cause some trauma to the vesselwall. Specifically, as indicated above, dilation of the vessel lumenwith a balloon or other expanding member is generally known to causetissue injury to the vessel wall. Further, penetration of the vesselwall with a dispenser will certainly cause some injury to vessel walltissue. Finally, the release of a medicament within the vessel wall willalso cause some injury to the tissue of the vessel wall.

[0008] These various forms of tissue injury will trigger an inflammationresponse. As indicated above, this inflammation response is widelyrecognized to contribute to the restenosis of the vessel. It is alsoknown that this inflammation response will cause localized changes nearthe injured tissue including increased permeability and increased bloodflow. This localized increase in blood flow and permeability willgenerally increase the dispersion rate of medicaments released near aninjury in a vessel wall.

[0009] For a medicament to be effective in preventing a restenosis itmust be delivered to a prescribed area and in a prescribed dosage. Asindicated above, the size, shape and location of the prescribedtreatment area is dependent on the amount and location of tissue injury.On the other hand, the amount of tissue injury is dependent on a numberof factors including the size of the balloon, the number of penetratingdispensers and the amount of medicament released. Further, thedispersion rate of the medicament will be affected by the amount ofinflammation, the type of medicament, and the amount of medicamentreleased. Consequently, all of these factors must be considered whendetermining the arrangement of the dispensers and the amount ofmedicament to be released at each dispenser that will result in auniform dispersion of medication at the prescribed treatment area.

[0010] In light of the above, it is an object of the present inventionto provide a method useful for preventing a restenosis caused by traumato vessel tissue from an intravascular procedure. It is another objectof the present invention to provide a method for preventing a restenosisin a vessel by delivering a medicament at predetermined locations withinthe vessel wall for dispersion into a prescribed shape that takesadvantage of the increased medicinal dispersion rate due to thelocalized inflammation created by the procedure. It is yet anotherobject of the present invention to prevent a restenosis by delivering amedicament at predetermined locations within a vessel wall to create acircumferential dispersion of the medicament within the vessel wall neara stenosis. Another object of the present invention is to safely deliverdangerous medicaments into a vessel wall while minimizing the amount ofmedicament which is washed away into the blood stream. Still anotherobject of the present invention is to provide a method for treating avessel which is easy to perform, safe, relatively simple, andinexpensive to perform.

SUMMARY OF THE PREFERRED EMBODIMENTS

[0011] The present invention is directed to a method for preventing arestenosis from occurring near the site of an intervascular catheterprocedure such as a balloon angioplasty procedure. In accordance withthe present method, the restenosis is prevented by medicating aprescribed treatment area within the vessel wall near the site of theangioplasty procedure. For the present method, a medicament known toprevent restenosis is delivered at predetermined locations within thevessel wall and allowed to subsequently disperse thereby medicating theprescribed treatment area. The delivery of the medicament can beaccomplished either during the angioplasty procedure or shortlythereafter.

[0012] In accordance with the present method, first, the shape, size andlocation of the treatment area to be medicated is prescribed. Forpurposes of the present invention, the treatment area is generally acircumferentially shaped volume (or annulus) within the vessel wall nearthe site of the catheter procedure. For angioplasty procedures thatdilate the lumen of the vessel near an existing stenosis, the presentmethod contemplates medication of an annulus near the treated stenosishaving a annulus length of approximately the size of the stenosis.Further, the prescribed annulus is preferably wholly contained within aparticular vessel layer. For example, in the case of an arterial vessel,the particular vessel layer may be the intima or the media. Next, thedelivery locations, delivery rates and delivery amounts are calculatedafter considering the dispersion rate of the medicament and the variousfactors that affect the dispersion rate such as the effect ofinflammation. Once the delivery locations, rates and amounts aredetermined, the arrangement and size of the medicament dispensers can bedetermined and used to configure a catheter for delivering themedicament.

[0013] To deliver the medicament in accordance with the present method,a catheter with an expanding member, such as a balloon, is advancedalong a catheter shaft within the lumen of a body vessel until theexpanding member is located adjacent to the prescribed treatment area. Aplurality of dispensers are mounted on the expanding member and anextracorporeal mechanism for pumping a medicinal fluid to the dispensersthrough a lumen in the catheter is provided. Importantly, in order tomedicate an annulus within the vessel wall as contemplated by thepresent method, all of the dispensers are positioned on the expandingmember in a plane oriented substantially perpendicular to the axis ofthe catheter shaft.

[0014] Once the expanding member is positioned adjacent to the treatmentarea, it can be activated to force the dispensers into the vessel wall.By the proper design and dimension of the expanding member anddispensers, the dispensers can be made to penetrate to the prescribedvessel layer. Once the dispensers have penetrated the vessel wall to theproper depth, a medicament can be selectively pumped through eachdispenser for release at the predetermined locations. Preferably, thedispensers create a plurality of equally spaced localized medicinaldeliveries which subsequently disperse to substantially medicate anannulus within the vessel wall. Simultaneously, the expanding member,which may be a balloon, can dilate the lumen of the vessel, therebyproducing results similar to the balloon angioplasty procedure describedabove.

[0015] As provided below, the expanding member selectively andaccurately controls the movement of the dispensers, and the medicamentsource selectively provides a pressurized supply of medicament to thedispensers. Thus, the expanding member mechanism which causes thedispensers to penetrate the vessel wall operates independently from theextracorporeal mechanism for pumping the medicinal fluid to thedispensers, thereby allowing greater freedom in medicinal delivery.

[0016] For the method of the present invention, the expanding member mayinclude a balloon which is expandable from a contracted, firstconfiguration to an expanded, second configuration. Preferably, thedispensers extend radially from the balloon and move with the balloonbetween the first configuration and the second configuration. Thisstructure allows the dispensers to penetrate into a prescribed targetvessel layer such as the intima or media for selective release of amedicament when the balloon is at the second configuration. Whenproperly designed, this structure allows both the depth of penetrationof the dispensers into the vessel wall and the force used to penetratethe vessel wall to be precisely controlled.

[0017] Further, for the method of the present invention, at least onefluid passageway provides for fluid communication between the medicamentsource and the dispensers. For example, the fluid passageway can includea flexible tubular sleeve which substantially encompasses and enclosesat least a portion of an outer surface of the balloon. The medicamentsource can also include an extracorporeal fluid pump which is in fluidcommunication with the fluid passageway for selectively providing apressurized supply of medicament from the medicament source to thedispensers.

[0018] Each dispenser can be a substantially tubular protrusion havingan attachment end and a penetrating section for penetrating the wall ofthe vessel. The attachment end includes a base plate which mountsdirectly onto the tubular sleeve. In some of the devices disclosedherein for use in the present method, an open edge defines thepenetrating section of the dispenser. In alternative devices useful forthe present method and disclosed herein, each dispenser can include aporous section or an opening through the dispenser wall which definesthe penetrating section.

[0019] Depending upon the medicament and the desired treatment, themedicament can be released while the dispenser penetrates the treatmentarea or there can be a time delay between the dispenser penetration andthe release of the medicament from the dispensers.

[0020] An alternative structure for the expanding member may include amulti-lumen catheter, a grommet, a plurality of flexible tubes whichconnect the grommet to the catheter and a dispenser secured to each ofthe flexible tubes. The grommet is movable relative to the catheter toreposition the flexible tubes near the vessel wall.

[0021] Various medicaments can be used in the method of the presentinvention depending on the needs of the individual patient. As indicatedabove, a medicament suitable for the treatment of a stenosis or diseasede novo, inhibiting a restenosis by minimizing the effects of a previousintravascular procedure and/or inhibiting a stenosis in a vessel may beused. For example, to inhibit a restenosis, the medicament may containan anti-proliferative agent which inhibits the proliferation of smoothmuscle cell growth in a vessel under certain pathological conditions.Further, medicaments which selectively kill rapidly dividing cells canalso be used to inhibit the proliferation of smooth tissue growth. Othersuitable medicaments can include anti-proliferative agents such asmethotrexate, prednisone, adriamycin, mitomycinc, protein synthesisinhibitors, toxin fragments such as pseudomonas, exotoxin (PE) or RicinA (RA) Toxin, and radioactive isotopes such as ¹¹¹Indium, ⁹⁰Yttrium,⁶⁷Gallium, ^(99m)Tc(Technetium 99), ²⁰⁵Thallium, and ³²P(Phosphorous 32)radiopharmaceutical. Alternatively, a medicament which stimulates theproduction of collateral vessels can be delivered to the target area bythe present method. This provides preventative treatment for the patientby creating new collateral vessels in the event the original vesseldevelops a stenosis. A medicament which includes an angiogenis factorcan be utilized for this purpose.

[0022] In order to decrease the amount of medicament washed away intothe blood stream, a portion of the medicament could precipitate atapproximately the vessel pH level of the vessel. Typically, the vesselpH is approximately 7. Thus, a medicament having a pH level of less thanapproximately 6 or greater than approximately 8 can be utilized. Afterthe medicament is dispensed into the wall of the vessel, the medicamentpH level approaches 7 and a portion of the medicament precipitates. Forthese purposes, the fluid can include a precipitator, an activecomponent attached to or included within the precipitator and a carriercomponent which carries the precipitator and the active component. Theprecipitator precipitates in the wall of the vessel while the carriercomponent gets washed away into the blood stream. Because the activecomponent is attached to or included within the precipitator, the activecomponent of the fluid remains in the vessel wall. This minimizes theamount of the active component of the fluid medicament which is washedaway into the blood stream. For these purposes, the active component ofthe medicament, for example, can include an anti-proliferative agent asdiscussed above. Alternatively, the precipitator and active component,for example, can include a radionuclide or radiopharmaceuticalprecipitate, such as gold colloidal, i.e. ¹⁹⁸Au and ¹⁹⁹Au, and/or aninorganic precipitate.

[0023] Additionally, the active component of the medicament can bedesigned to have a slow, time-release formulation so that the activecomponent is released to the vessel wall over an extended period oftime. Stated another way, the active component can biodegrade slowlyover a period of time to gradually release the active component of themedicament into the vessel wall. A biodegradable polymer could be usedto provide a control release formulation to the active component.

[0024] Alternatively, the medicament could include a binder secured tothe active component of the medicament. The binder binds, attaches orcrosslinks to at least a portion of the wall of the vessel. The bindercan include a ligand which binds to a portion of the vessel wall such ascollagen or the smooth muscle cell component of the vessel wall. Thisensures that the bulk of the active component of the medicament remainsin the vessel wall and minimizes the amount of the active component ofthe medicament which is washed away into the blood stream. Examples ofligands binding to the vessel wall components include PDGF receptors,adhesive molecules including, but not limited to certain molecules ofthe integrin family and receptors on activated platelets such asthrombin receptors. Alternatively, for example, phosphors tridentitewhich binds to collagen can be utilized. Further, a binder that has adirect affinity to form ionic bonds, covalent bonds or Van der Waalattractions to the wall of the vessel or some component thereof can beused in the method of the present invention.

[0025] Further, a medicament for performing gene therapy on the vesselwall can be used. For example, the medicament could include eitherretroviral, adenoviral vectors or Adenovirus Associated Vectors (AAV)carrying the appropriate DNA payload for appropriate gene switching. Themethod of the present invention also allows for the use of medicamentswhich genetically alter the specific treatment site of the vesselwithout effecting the rest of the body. Additionally, the method of thepresent invention may be used to inject radioactive isotopes directlyinto the vessel wall.

BRIEF DESCRIPTION OF THE DRAWINGS

[0026] The novel features of this invention, as well as the inventionitself, both as to its structure and its operation will be bestunderstood from the accompanying drawings, taken in conjunction with theaccompanying description, in which:

[0027]FIG. 1A is a perspective view of a patient with a devicepositioned in an artery of the patient in accordance with the method ofthe present invention;

[0028]FIG. 1B is a perspective view of a portion of an artery of apatient showing the intima, media and adventitia layers;

[0029]FIG. 1C is a perspective view of a portion of an artery of apatient showing a circumferential dispersment of a medicament (inphantom) in accordance with the method of the present invention;

[0030]FIG. 2 is a perspective view of a device suitable for use in themethod of the present invention;

[0031]FIG. 3A is a cross-sectional view of the device of FIG. 2 as seenalong line 3-3 in FIG. 2, positioned in an artery of a patient;

[0032]FIG. 3B is a cross-sectional view of an artery showing a dispenserpositioned for release of a fluid medicament in the media layer of theartery;

[0033]FIG. 4A is a perspective view of a first embodiment for adispenser suitable for use in the present invention;

[0034]FIG. 4B is a perspective view of a second embodiment for adispenser suitable for use in the present invention;

[0035]FIG. 5A is a side plan view of a third embodiment of a dispensersuitable for use in the present invention;

[0036]FIG. 5B is a side plan view of a fourth embodiment of a dispensersuitable for use in the present invention;

[0037]FIG. 5C is a side plan view of a fifth embodiment of a dispensersuitable for use in the present invention;

[0038]FIG. 6 is a perspective view of another embodiment of a devicesuitable for use in the present invention;

[0039]FIG. 7 is a cross-sectional view of the device shown in FIG. 6 asseen along line 7-7 in FIG. 6;

[0040]FIG. 8 is a perspective view of yet another embodiment of a devicesuitable for use in the present invention;

[0041]FIG. 9 is a cross-sectional view of the device of FIG. 8 shown ina retracted configuration, as seen along line 9-9 in FIG. 8;

[0042]FIG. 10 is a cross-sectional view of the device of FIG. 8 shown inan expanded configuration, as seen along the line 9-9 in FIG. 8;

[0043]FIG. 11 is a cross-sectional view of the device of FIG. 8positioned in the blood vessel of a patient;

[0044]FIG. 12A is a longitudinal cross-sectional view of a portion ofthe vessel and a device prior to a dispenser penetrating the vesselwall;

[0045]FIG. 12B is a longitudinal cross-sectional view of a portion ofthe vessel and a portion of the device after a dispenser penetrates thevessel wall;

[0046]FIG. 12C is an axial cross-sectional view of the vessel and thedevice illustrating the dispensers penetrating the vessel wall;

[0047]FIG. 12D illustrates a longitudinal cross-sectional view of theintima layer of the vessel wall after the fluid medicament has beeninjected into the vessel wall;

[0048]FIG. 12E is an axial cross-sectional view illustrating the intimalayer of the vessel wall after the fluid medicament has been injectedinto the vessel wall;

[0049]FIG. 12F is a longitudinal cross-sectional view of a portion ofthe intima layer of the vessel and the device illustrating the fluidmedicament after dispersion in the vessel wall;

[0050]FIG. 12G is an axial cross-sectional view of the intima layer ofthe vessel and the device illustrating the fluid medicament afterdispersion in the vessel wall;

[0051]FIG. 13A is a longitudinal cross sectional view of the vessel anda device illustrating a fluid medicament containing a radioactiveisotope being injected into the vessel wall;

[0052]FIG. 13B is a longitudinal cross sectional view of a portion ofthe vessel and the device after a fluid medicament containing aradioactive isotope is injected into the vessel wall;

[0053]FIG. 14A is a longitudinal cross-sectional view of a portion ofthe vessel and the device after a fluid medicament containing aprecipitant is injected into the vessel wall;

[0054]FIG. 14B is a longitudinal cross-sectional view of a portion ofthe vessel and the device after a portion of an injected fluidmedicament precipitates within the vessel wall;

[0055]FIG. 15A is a longitudinal cross-sectional view of a portion ofthe vessel and the device after a fluid medicament with a binder hasbeen injected into the vessel wall;

[0056]FIG. 15B is a longitudinal cross-sectional view of a portion ofthe vessel and the device showing the binder of an injected medicamentbinding to a portion of the vessel wall;

[0057]FIG. 16A is a longitudinal cross-sectional view of a portion of avessel and device illustrating the cell genes of the vessel prior topenetration of the vessel with the dispenser;

[0058]FIG. 16B is a longitudinal cross-sectional view of a portion of avessel and device illustrating the vessel after a fluid medicament thatincludes a virus gene is injected into the wall of the vessel by thedevice; and

[0059]FIG. 16C is a longitudinal cross-sectional view of a portion ofthe vessel and device illustrating the vessel wall after the injectedvirus genes have attacked and replaced the cell genes.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0060] Referring initially to FIG. 1A, a device 10 for injecting a fluidmedicament 13 into a wall 23 of a living blood vessel 11 in accordancewith the method of the present invention is shown positioned in an upperbody, blood vessel 11 of a patient 12. It is to be appreciated that thepresent method can be used in arteries and other vessels throughout thebody of the patient 12. FIG. 1B shows the wall 23 of an arterial bloodvessel 11 having three layers of importance for the present invention,the intima 35, the media 37 and the adventitia 39. As shown in FIG. 1C,the intima 35 surrounds the lumen 21 of the blood vessel 11.Importantly, as provided in detail below, the device 10 when used inaccordance with the method provided herein, allows for a substantiallycircumferential dispersion of the fluid medicament 13 within the wall 23of the blood vessel 11, as shown in FIG. 1C. Further, in accordance withthe present method, a circumferential dispersion of fluid medicament 13can be made within one of the layers 35, 37, 39 of wall 23 of the bloodvessel 11.

[0061] Referring to FIGS. 2 and 3A, a first version of a device 10suitable for the method of the present invention includes a multi-lumencatheter 14, an expanding member 15 mounted thereon, a tubular sleeve 18and a plurality of dispensers 20. Although FIGS. 2 and 3A show theexpanding member 15 as an inflatable balloon 16, any expanding memberknown in the art may be used. The balloon 16 is inflatable anddeflatable between a first, substantially deflated configuration and asecond, substantially expanded configuration. The balloon 16, while inthe second configuration, can be anywhere from partially inflated tofully inflated depending upon the size of the blood vessel 11. Theballoon 16 and tubular sleeve 18 can be made of a number of materialsincluding polyethylene terephthalate (PET). As shown in FIG. 2, thetubular balloon 16 defines a longitudinal axis 17.

[0062] Further, FIG. 2 indicates that the tubular sleeve 18 surrounds asubstantial portion of the balloon 16, and that a plurality ofdispensers 20 are mounted onto the tubular sleeve 18. Of these, thenumber of dispensers 20 illustrated is only exemplary. Importantly forthe present method, all dispensers 20 are positioned in a single plane19 that, as shown, is oriented substantially normal to the longitudinalaxis 17. Also, it is preferable for the present method that thedispensers 20 be equally spaced around the axis 17.

[0063] A more complete appreciation of the structural cooperationbetween the balloon 16, the tubular sleeve 18 and the dispensers 20 isprovided by FIG. 3A wherein, it will be seen that a distal end 22 oftubular sleeve 18 is attached directly to an outer surface 25 of balloon16. By cross-referencing FIGS. 2 and 3A it can be seen that the tubularsleeve 18 substantially surrounds and encloses the balloon 16 and that aproximal end 24 of tubular sleeve 18 extends proximally from and beyondthe balloon 16 over catheter 14. The tubular sleeve 18 cooperates withthe outer surface 25 of the balloon 16 to define a portion of a fluidpassageway 26. The proximal end 24 can be connected to an outer lumen 27(not shown in FIG. 3A) of the catheter 14 to complete the fluidpassageway 26.

[0064]FIG. 3A further shows that the distal end 28 of balloon 16 isaffixed to the catheter 14, and that the proximal end 30 of the balloon16 attaches onto the catheter 14 to create an inflation chamber 32 inthe interior of the balloon 16. A balloon port 34 provides fluid accessinto the inflation chamber 32. For purposes of the present invention,the balloon port 34 can be connected in fluid communication with aballoon lumen (not shown) of the catheter 14. FIG. 3A also shows thatcatheter 14 is formed with an inner lumen 36 which is dimensioned toreceive a guidewire 38 therethrough.

[0065] As discussed previously, the wall 23 of the blood vessel 11includes multiple layers. To facilitate the present discussion, some ofthe layers, namely, the intima layer 35, the media layer 37, and theadventitia layer 39 are illustrated in FIG. 1B and again in FIG. 3B.Importantly, when the device 10 is used in accordance with the presentmethod, the depth of penetration of each dispenser 20 can be preciselycontrolled by controlling the length 41 (shown in FIG. 5A) of eachdispenser 20. In accordance with the method of the present invention,the dispensers 20 extend a length 41 of between approximately 0.005inches and approximately 0.02 inches from the tubular sleeve 18 when theballoon 16 is inflated. However, those skilled in the pertinent art willrecognize that these distances are merely exemplary. Thus, the device 10is able to deliver the fluid medicament 13 to a desired, target layer inthe wall 23 of the blood vessel 11. For example, as illustrated in FIG.3B, the dispenser 20 penetrates through the intima layer 35 andprecisely delivers the fluid medicament 13 to the media layer 37, i.e.the target layer in this example. It is to be appreciated that a shorterdispenser 20 could be utilized to deliver the fluid medicament 13 to theintima layer 35. Additionally, in accordance with the method of thepresent invention, the device 10 can be used to simultaneously releasethe fluid medicament 13 within a target layer and dilate the lumen 21 ofthe blood vessel 11.

[0066] Referring now to FIG. 4A, each dispenser 20 includes a base plate40 and a tubular protrusion 42 having an attachment end 44 and apenetrating section 46. Further, it is seen that the attachment end 44of the tubular protrusion 42 affixes to and is an integral part of thebase plate 40. Preferably, the dispenser 20 is made of nickel and thetubular protrusion 42 is formed by punching out the base plate 40. Inthe dispenser embodiment illustrated in FIG. 4A, the penetrating section46 is defined by an opening which is opposite the base plate 40. Thetubular protrusion 42 defines a fluid channel 48 which extends throughthe dispenser 20. The penetrating section 46 of the dispenser 20 shownin FIG. 4A is substantially annular shaped.

[0067]FIG. 4B shows another embodiment of the dispenser 20. In thisembodiment, each tubular protrusion 42 is substantially conical shapedas shown in FIG. 4B. Like the embodiment shown in FIG. 4A, the dispenser20 shown in FIG. 4B is preferably made of nickel and is formed with afluid channel 48 which extends through the dispenser 20.

[0068]FIGS. 5A, 5B and 5C illustrate additional, alternative embodimentsof the dispenser 20. In the embodiments illustrated in FIGS. 5A, 5B and5C, the tubular protrusion 42 is substantially conical shaped. However,in FIG. 5A, the penetrating section 46 is defined by an opening whichextends through the side of the tubular protrusion 42. Somewhatsimilarly, in FIG. 5B, the penetrating section 46 is defined by a pairof openings which extend through the side of each tubular protrusion 42.This feature inhibits plugging of the penetrating section 46 duringinsertion into the wall 23 of the blood vessel 11. In FIG. 5C, thetubular protrusion 42 is made of a porous material. Thus, the porousmaterial defines the penetrating section 46 of each dispenser 20. In theembodiment shown in FIG. 5C, the fluid medicament 13 is forced throughthe pores 49 of the porous tubular protrusion 42.

[0069] Referring now to FIG. 3A, the dispensers 20 are mounted on thetubular sleeve 18 so that the fluid channel 48 of each respectivedispenser 20 is aligned with a hole 52 in the tubular sleeve 18. This isdone to establish fluid communication between the particular dispenser20 and the fluid passageway 26. As a practical matter, it may bepreferable in the construction of the device 10 to first mount thedispenser 20 on the tubular sleeve 18, which can be done in any mannerwell known in the pertinent art, such as by bonding, and then pierce ahole 52 in the tubular sleeve 18 through the dispenser 20.

[0070] An alternative structure for a device 10 suitable for use in thepresent method is shown in FIG. 6. As shown, the alternative device 10includes a multi-lumen catheter 14 formed to accommodate a guidewire 38,a balloon 16, a plurality of dispensers 20 and a plurality of tubularchannels 64 mounted on the outer surface 25 of the balloon 16. Eachtubular channel 64 has a smaller diameter than the balloon 16 and ispositioned to be substantially parallel with a longitudinal axis 65 ofthe balloon 16.

[0071]FIG. 6 further shows that mounted on the surface of each tubularchannel 64 is a dispenser 20. The dispensers 20 are positioned on thesurface of tubular channel 64 so that when balloon 16 is inflated, thedispensers 20 move outwardly from the longitudinal axis 65 in a radialdirection. Importantly for the present method, all dispensers 20 arepositioned in a single plane 67 that is oriented substantially normal tothe longitudinal axis 65 of the balloon 16. Further, it is preferablefor the present method that the dispensers 20 be equally spaced aroundthe longitudinal axis 65.

[0072] Referring now to FIG. 7, the cross-sectional view of thealternative device 10 shows the tubular channel 64 in more detail. Morespecifically, a distal end 66 of tubular channel 64 is sealed to createa portion of the fluid passageway 26 which connects the dispensers 20 tothe fluid source 60. Referring to FIGS. 6 and 7, it is to be appreciatedthat the proximal end 68 of the tubular channel 64 is in fluidcommunication with the outer lumen 27 of the catheter 14. In turn, theouter lumen 27 is connected in fluid communication with the fluid pump58 and the fluid medicament source 60.

[0073] Still referring to FIG. 7, the dispensers 20 are shown mounted onthe surface of the tubular channel 64. As FIG. 7 further shows indetail, a base plate 40 of a dispenser 20 is mounted on the tubularchannel 64 over a corresponding hole 70. From this view, it can beappreciated that any number of tubular channels 64 could be mounted onthe external surface of balloon 16.

[0074]FIG. 8 shows yet another version of a device 10 suitable for themethod of the present invention. In this version of the device 10, theexpanding member 15 includes a multi-lumen catheter 80 and a grommet 82.Both the multi-lumen catheter 80 and the grommet 82 are disposed aboutthe same longitudinal axis 97 with the grommet 82 positioned distally,and separated from, the distal end 88 of the multi-lumen catheter 80.

[0075] A mechanism is provided to move the grommet 82 translationallyalong the longitudinal axis 97. For example, referring to FIG. 8, apush-pull wire 84, is shown connected to the grommet 82. The push-pullwire 84 extends through one of the lumens of the multi-lumen catheter 80allowing the push-pull wire 84 to move translationally in line with thelongitudinal axis 97. The translational movement of the push-pull wire84 causes the grommet 82 to undergo a similar translationaldisplacement. Further, this version of the device 10 can be used incombination with the guidewire 38, as shown in FIG. 8. Specifically, thepush-pull wire 84 may be formed with an internal lumen, allowing thecatheter 80 and push-pull wire 84 to pass over the guidewire 38.

[0076] In the version of the device 10 shown in FIG. 8, a plurality ofhollow, flexible tubes 86 are attached between the grommet 82 and themulti-lumen catheter 80. Each of the flexible tubes 86 includes a distalend 88, a proximal end 90 and a central region 92. The proximal end 90of each tube 86 is joined to the multi-lumen catheter 80. The distal end88 of each tube 86 is joined to the grommet 82. Preferably, the tubes 86are distributed radially around the multi-lumen catheter 80 and grommet82 in a manner substantially as shown in FIG. 8.

[0077] Referring now to FIGS. 9-11, it may be seen that each flexibletube 86 is formed with a lumen 94. The lumen 94 of each flexible tube 86passes through the multi-lumen catheter 80 allowing fluid medicament 13to be passed through multi-lumen catheter 80 and into flexible tubes 86.The lumen 94 of each flexible tube 86 passes separately throughmulti-lumen catheter 80 allowing a different fluid medicament 13 to bepassed into each flexible tube 86. Alternatively, the lumen 94 of eachflexible tube 86 may be attached to one or more common lumens within themulti-lumen catheter 80.

[0078] Referring to FIGS. 8 and 9, it is shown that a dispenser 20 isattached to the central region 92 of each flexible tube 86. Eachflexible tube 86 is formed with a hole 96 which correspond to arespective dispenser 20. Functionally, each hole 96 connects the fluidchannel 48 of a respective dispenser 20 to lumen 94 allowing the fluidpump 58 to pump fluid medicaments 13 from the fluid source 60 into lumen94 to be expelled through the dispensers 20. Importantly for the presentmethod, all dispensers 20 are positioned in a single plane 95 orientednormal to the longitudinal axis 97 defined by the expanding member 15.Further, it is preferable for the present method that the dispensers 20are equally spaced around the longitudinal axis 97.

[0079] Referring now to FIGS. 9 and 10, it is shown that the device 10is movable between the first, contracted configuration (shown in FIG. 9)and the second, expanded configuration (shown in FIG. 10). Specifically,it may be seen that the grommet 82 and the multi-lumen catheter 80 aredistanced by a first separation distance 98. The device 10 shown in FIG.9 also has a first overall width designated 100. In comparison, thegrommet 82 and the multi-lumen catheter 80 shown in FIG. 10 aredistanced by a second separation distance 102 which is smaller than thefirst separation distance 98 of FIG. 9. The device 10, shown in FIG. 10also has a second overall width 104 which is greater than the firstoverall width 100 shown in FIG. 9.

[0080] The movement between the first, contracted configuration shown inFIG. 9 and the second, expanded configuration shown in FIG. 10 isaccomplished by the translational movement of the grommet 82 along thelongitudinal axis 97. Specifically, as the push-pull wire 84 causes thegrommet 82 to move towards the multi-lumen catheter 80, each of theflexible tubes 86 bows outwardly away from the longitudinal axis 97. Inthis manner, the push-pull wire 84 may be used to move the grommet 82translationally to cause the flexible tubes 86 to alternately bow, asseen in FIG. 10, and straighten, as seen in FIG. 9. In some cases, itwill be preferable to fabricate the flexible tubes 86 from a resilientmaterial and shape the flexible tubes 86 to be initially biased ineither a bowed or straight configuration.

[0081] FIGS. 12A-12F show the process whereby the fluid medicament 13 ispumped from each dispenser 20 into the intima layer 35 of an exemplaryblood vessel 11 and then allowed to disperse. FIGS. 12A-12F further showthat the fluid medicament 13 can be pumped into a target layer, in thiscase the intima 35, and allowed to disperse until a circumferentialdispersion of fluid medicament 13 is achieved. First, as shown in FIG.12A, the dispenser 20 is positioned adjacent to the target area of theblood vessel 11. Next, as shown in FIGS. 12B and 12C, the expandingmember 15 is expanded, forcing the dispenser 20 to penetrate the targetlayer (in this case, the intima 35). Preferably, as illustrated in FIG.12C, the dispensers 20 are circumferentially spaced to create aplurality of spaced apart medicinal deliveries 106. FIGS. 12D and 12Eshow the medicinal deliveries 106 which are confined to the intima layer35. FIGS. 12F and 12G show the subsequent dispersion of the fluidmedicament 13 around a circumference of the wall 23 of the blood vessel11, creating a circumferential dispersion. The pumping rate required toachieve the desired circumferential dispersion depends upon theviscosity of the fluid medicament 13 utilized. Typically, betweenapproximately 400 microliters and 700 microliters of the fluidmedicament 13 is dispensed during a period of between approximately fiveand forty-five seconds to create the desired medicinal delivery 106 thatwill result in a circumferential dispersion. However, it should berecognized that the amounts and time frames provided herein are merelyexemplary. It is also to be appreciated that the medicinal dispersionrate will be affected by the body's response (inflammation) to thetissue injury caused by the present method.

[0082] Further, the spacing required to create a plurality of spacedapart medicinal deliveries 106 which subsequently disperse the fluidmedicament 13 along the treatment area 54 will also vary according tothe fluid medicament 13 utilized. It is contemplated for the presentmethod that the dispensers 20 are to be spaced a circumferentialdistance 108 of between approximately 1 millimeter and 6 millimeters,roughly 70 degrees and 140 degrees apart.

[0083] The composition of the fluid medicament 13 to be injected intothe wall 23 of the blood vessel 11 depends upon the treatment beingperformed and the physical characteristics of the patient 12. Morespecifically, the fluid medicament 13 can be designed to treat astenosis or disease de novo, inhibit a restenosis by minimizing theeffects of a previous intravascular procedure and/or inhibit a stenosisin a blood vessel 11. For example, to inhibit a restenosis, the fluidmedicament 13 can contain anti-proliferative agents which inhibit theproliferation of smooth muscle cell growth in the vessel in certainpathological conditions. These fluids selectively kill rapidly dividingcells and can be utilized to inhibit the proliferation of smooth tissuegrowth. Suitable fluids can include anti-proliferative agents such asmethotrexate, prednisone, adriamycin, mitomycinc, protein synthesisinhibitors, toxin fragments such as pseudomonas, exotoxin (PE) or RicinA (RA) Toxin, and radioactive isotopes 112 such as ¹¹¹Indium, ⁹⁰Yttrium,⁶⁷Gallium, ^(99m)Tc (Technetium 99), ²⁰⁵Thallium, and ³²P (Phosphorous32) radiopharmaceutical. It is believed that the present method isuniquely suited to safely deliver toxic fluid medicaments 13 into thewall 23 of the blood vessel 11 while minimizing the amount of fluidmedicament 13 which is washed away into the blood stream.

[0084] Alternatively, for example, a fluid medicament 13 whichstimulates the production of collateral vessels can be delivered by thepresent method. These fluid medicaments 13 provide preventativetreatment for the patient 12 by creating new collateral vessels in theevent the original blood vessel 11 develops a stenosis. A fluidmedicament 13 which includes an angiogenis factor can be utilized forthis purpose.

[0085]FIGS. 13A and 13B, illustrate the delivery and dispersion of afluid medicament 13 that includes a radioactive isotope 112 which canreduce and inhibit tissue and/or cell growth of the wall 23 of the bloodvessel 11. Because the radioactive isotopes 112 are injected directly inthe wall 23 of the blood vessel 11 and are symmetrically injected aroundthe circumference of the wall 23 of the blood vessel 11, relatively lowenergy radioactive isotopes 112 having a relatively short half life canbe utilized. These relatively low energy radioactive isotopes 112 shouldcause minimal trauma to the patient 12. The present method providedherein is uniquely suited to safely deliver a radioactive isotope 112 toonly the treatment area 54 of the wall 23 of the blood vessel 11, whileminimizing the amount of radioactive isotope 112 which is washed awayinto the blood stream. Additionally, the radioactive isotope 112 can beencapsulated within a suitable carrier such as amino-mannose modifiedliposome, which is rapidly absorbed into the smooth muscle cells of theintima layer 35.

[0086] The exact dose of radiation to be delivered to the wall 23 of theblood vessel 11 can be varied to suit the needs of the patient 12. It ispresently believed that a tissue absorbed dose of between approximately8-40 Gray will be utilized to inhibit restenosis. The exact amount offluid medicament 13 and type of fluid medicament 13 injected into thewall 23 of the blood vessel 11, can be varied to account for fluidmedicament 13 washed into the blood stream and/or account for the activelife of the fluid medicament 13.

[0087] Referring to FIGS. 14A and 14B, it is shown that a precipitationprocess can be used to minimize the amount of fluid medicament 13 whichis washed away into the blood stream. Specifically, a portion of thefluid medicament 13 can be precipitated at approximately the pH level ofthe wall 23 of the blood vessel 11. Typically, the vessel pH isapproximately 7. A fluid medicament 13 containing a precipitator 114,and having a fluid pH level of less than approximately 6 or greater thanapproximately 8 can be utilized. After the fluid medicament 13 andprecipitator 114 are dispensed into the wall 23 of the blood vessel 11,the fluid medicament pH level will approach 7, and a portion of thefluid medicament 13 may precipitate. For this embodiment, the fluidmedicament 13 could include a precipitator 114, an active component 115attached to or incorporated within the precipitator 114 and a carriercomponent 117 which carries the precipitator 114 and the activecomponent 115. The active component 115 is the portion of the fluidmedicament 13 which is designed to treat the patient 12. In thisexample, the precipitator 114 could precipitate in the wall 23 of theblood vessel 11 while the carrier component 117 gets washed away intothe blood stream.

[0088] Because the active component 115 is attached to or incorporatedwithin the precipitator 114, this ensures that the bulk of the activecomponent 115 of the fluid medicament 13 remains in the wall 23 of theblood vessel 11 and minimizes the amount of the active component 115 ofthe fluid medicament 13 which is washed away into the blood stream. Inthis embodiment, the active component 115 of the fluid medicament 13,for example, can include an anti-proliferative agent as outlined above.Alternatively, the precipitator 114 and the active component 115 can bea radionuclide or radiopharmaceutical precipitate, such as goldcolloidal, i.e. ¹⁹⁸Au and ¹⁹⁹Au, and/or an inorganic precipitate such asorgano-metallic precipitate.

[0089] Additionally, the active component 115 of the fluid medicament 13can be designed to have a slow, time-release formulation so that activecomponent 115 is released to the wall 23 of the blood vessel 11 over anextended period of time. Stated another way, the active component 115can biodegrade slowly over a period of time to release the activecomponent of fluid medicament 13 into the wall 23 of the blood vessel 11over an extended period of time. A biodegradable polymer may be used toprovide a control release formulation to the active component 115.

[0090] Alternatively, referring to FIGS. 15A and 15B, the fluidmedicament 13 may include a binder 116, the active component 115 and thecarrier component 117. The binder 116 is secured to the active component115 of the fluid medicament 13. The binder 116 is adapted to bind,attach and/or crosslink to at least a portion of the wall 23 of theblood vessel 11. For example, the binder 116 could include a ligandwhich binds to a portion of the wall 23 of the blood vessel 11 such ascollagen or the smooth muscle cell component of the wall 23 of the bloodvessel 11. Because the binder 116 is secured to the active component115, this ensures that the bulk of the active component 115 of the fluidmedicament 13 remains in the wall 23 of the blood vessel 11 andminimizes the amount of the active component 115 of the fluid medicament13 which is washed away into the blood stream. Examples of ligandscapable of binding to the arterial wall components include PDGFreceptors, adhesive molecules including, but not limited to certainmolecules of the integrin family, and receptors on activated plateletssuch as thrombin receptors. Another suitable type of ligand is soldunder the name CERETEC® by Amersham located in Arlington Heights, Ill.Alternatively, for example, phosphors tridentite which binds to collagencan be utilized. In yet an alternative embodiment, the binder 116 canhave a direct affinity to form ionic bonds, covalent bonds or Van derWaal attractions with the wall 23 of the blood vessel 11 or somecomponent thereof.

[0091] Alternatively, as illustrated in FIGS. 16A-16C, the fluidmedicament 13 can be used for gene therapy on the wall 23 of the bloodvessel 11. In this embodiment, the fluid medicament 13 can include asuitable viral vector 118 which is adapted to infect a cell 120 andreplace, modulate, inhibit or enhance one of the cell genes 122 withinthe cell 120. For example, the fluid medicament 13 could include aretroviral, adenoviral vectors or Adenovirus Associated Vectors (AAV)carrying the appropriate DNA payload for appropriate gene switching.Alternatively, for example, naked DNA or polycation-condensed DNA couldbe utilized for gene therapy. The method of the present invention allowsfor the use of fluid medicaments 13 which genetically alter thetreatment area 54 of the wall 23 of the blood vessel 11 withouteffecting the rest of the body.

[0092] Still other fluid medicaments 13 which could be utilized with themethod of the present invention include antibodies such as receptor sitemonoclonal antibodies, a toxic agent such as saponin, a genetic materialsuch as DNA, a cellular material such as endothelial cells and/ormedicaments such as heparin. The examples provided herein are merelyexamples of fluid medicaments 13 which may be useful with the presentinvention. Those skilled in the art will recognize that additional fluidmedicaments 13 will be developed as medical technology improves.Additionally, those skilled in the art will recognize that the presentinvention can be utilized for applications other than inhibiting arestenosis. For example, with extended dispensers 20, the method of thepresent invention could deliver fluid medicaments 13 from the bloodvessel 11 to specific organs.

OPERATION

[0093] An example of the operation of the balloon 16 version of theexpanding member 15 can best be visualized with initial reference toFIGS. 1-3. First, the guidewire 38 is positioned into the blood vessel11 of the patient 12. This is done to establish a mechanical pathwaythrough the blood vessel 11 to the treatment area 54 where the fluidmedicament 13 is to be released.

[0094] Next, the balloon 16, which is attached to the catheter 14, ismoved over the guidewire 38 to the treatment area 54. The balloon 16 isat its first configuration during movement over the guidewire 38 in theblood vessel 11. Once the balloon 16 is properly positioned proximatethe treatment area 54, an inflator 56 is activated to inflate theballoon 16 to its second configuration. As shown in FIG. 2, the inflator56 is connected to the proximal (extracorporeal) end 29 of the catheter14.

[0095] Referring back to FIGS. 3A and 3B, it will be appreciated that,as the balloon 16 is inflated, the expanding balloon 16 urges againstthe tubular sleeve 18 and causes the tubular sleeve 18 to likewiseexpand. Consequently, the dispensers 20 mounted on the tubular sleeve 18move radially from the longitudinal axis 17 and embed into the treatmentarea 54. Further, the balloon 16 can be used to simultaneously dilatethe lumen 21 of the blood vessel 11.

[0096] With the dispensers 20 embedded into the treatment area 54, thefluid pump 58 shown in FIG. 2 is activated to pump a fluid medicament 13from the fluid medicament source 60 into the fluid passageway 26.Importantly, this pumping action also causes any fluid medicament 13which has already been pumped into the fluid passageway 26 to beexpelled through the fluid channels 48 of dispensers 20 and into thetissue of treatment area 54.

[0097] Alternatively, the fluid pump 58 could be activated prior toembedding the dispensers 20 into the wall 23 of the blood vessel 11 anda valve 62 could be used to prevent the flow of fluid medicament 13until the dispensers 20 are embedded in the treatment area 54. The valve62 can then be opened when the dispensers 20 penetrate into thetreatment area 54 so that injection occurs substantially simultaneouslywith the embedding of the dispensers 20 in the treatment area 54.Alternatively, the injection of the fluid medicament 13 could happenafter a time delay by waiting to open the valve 62 for at least aboutone second to about twenty seconds. Further, one or more fluidmedicaments 13 can be released at different time intervals in the wall23 of the blood vessel 11.

[0098] After the fluid medicament 13 from the fluid medicament source 60has been dispensed into the treatment area 54, the balloon 16 can bedeflated to the first configuration by reversing the inflator 56. Thisaction will cause the balloon 16 to collapse and withdraw the dispensers20 from the treatment area 54. The entire device 10 can then bewithdrawn from the patient 12 over the guidewire 38.

[0099] The embodiment shown in FIG. 6 utilizes a plurality ofindividual, tubular channels 64. With this embodiment, it is possible toeither maintain fluid communication with, or fluid isolation between,each tubular channel 64. For example, fluid communication between eachtubular channel 64 can be established by fluidly connecting each tubularchannel 64 together within one outer lumen 27 of the catheter 14 so thateach tubular channel 64 is supplied fluid medicament 13 from the samefluid pump 58. Alternatively, fluid isolation may be maintained betweeneach tubular channel 64 by providing each tubular channel 64 with acorresponding and independent outer lumen 27 and establishing its ownfluid connection to a corresponding and independent fluid pump 58.Consequently, it is possible to inject a variety of alternate fluidmedicaments 13 simultaneously by using a plurality of tubular channels64 which are each connected to a separate fluid pump 58.

[0100] While the particular Method for Delivering Medication Into anArterial Wall for Prevention of Restenosis as herein shown and disclosedin detail is fully capable of obtaining the objects and providing theadvantages herein before stated, it is to be understood that it ismerely illustrative of the presently preferred embodiments of theinvention and that no limitations are intended to the details of theconstruction or design herein shown other than as defined in theappended claims.

What is claimed is:
 1. A method for releasing fluid medicaments at asite in the vasculature of a patient to prevent a restenosis in thelumen of a vessel comprising the steps of: providing an expanding memberdefining an axis and having a plurality of dispensers mounted on saidexpanding member for movement therewith, said dispensers beingpositioned in a plane oriented substantially perpendicular to said axis;advancing said expanding member through the vasculature to the site;moving said expanding member between a first configuration wherein saiddispensers are positioned substantially adjacent said axis of saidexpanding member, and a second configuration wherein said dispensers areradially extended from said axis for contact with the vessel wall at thesite in the vasculature; and releasing said fluid medicament throughsaid dispensers into the vessel wall for a substantially circumferentialdispersion of said fluid medicament through said wall around the lumenof the vessel.
 2. The method of claim 1 wherein said fluid medicamentinhibits the proliferation of smooth tissue growth in the vessel.
 3. Themethod of claim 1 wherein said fluid medicament comprises a radioactiveisotope.
 4. The method of claim 1 wherein said fluid medicamentstimulates the production of collateral vessels.
 5. The method of claim1 wherein said fluid medicament comprises ^(99m)Tc (Technetium 99). 6.The method of claim 1 wherein said fluid medicament partly precipitatesat approximately a vessel pH level of the vessel.
 7. The method of claim1 wherein said fluid medicament comprises a binder which binds to atleast a portion of the vessel wall.
 8. The method of claim 1 whereinsaid fluid medicament comprises ³²P(Phosphorous 32).
 9. The method ofclaim 1 wherein said fluid medicament comprises a gene for gene therapy.10. A method for releasing fluid medicaments into a vessel wall of apatient to treat for a vessel disease at a treatment site, the vesselwall including a plurality of internal layers with one of the layersbeing a target layer, the method comprising the steps of: providing anexpanding member defining an axis and having a plurality of dispensersmounted thereon for movement therewith, said dispensers being positionedin a plane oriented substantially perpendicular to said axis; advancingsaid expanding member through the vessel to the site; moving saidexpanding member between a first configuration wherein said dispensersare positioned substantially adjacent said axis of said expandingmember, and a second configuration wherein said dispensers are radiallyextended from said axis for penetrating into the target layer of thevessel wall; and releasing said fluid medicament through said dispensersinto the target layer of the vessel wall for a substantiallycircumferential dispersion of said fluid medicament through said targetlayer of said wall around the lumen of the vessel.
 11. The method ofclaim 10 wherein the vessel wall is an artery having an intima layer andthe target layer is the intima layer.
 12. The method of claim 11 whereinsaid fluid medicament inhibits the proliferation of smooth tissue growthin the vessel.
 13. The method of claim 11 wherein said fluid medicamentcomprises a radioactive isotope.
 14. The method of claim 11 wherein saidfluid medicament stimulates the production of collateral vessels. 15.The method of claim 11 wherein said fluid medicament comprises ^(99m)Tc(Technetium 99).
 16. The method of claim 11 wherein said fluidmedicament partly precipitates at approximately a vessel pH level of thevessel.
 17. The method of claim 11 wherein said fluid medicamentcomprises a binder which binds to at least a portion of the vessel wall.18. The method of claim 11 wherein said fluid medicament comprises³²P(Phosphorous 32).
 19. The method of claim 11 wherein said fluidmedicament comprises a gene for gene therapy.
 20. A method for releasingfluid medicaments into an arterial wall of a patient to treat for anarterial disease at a treatment site, the arterial wall including amedia layer, the method comprising the steps of: providing an expandingmember defining an axis, and having a plurality of dispensers mountedthereon for movement therewith, said dispensers being positioned in aplane oriented substantially perpendicular to said axis; advancing saidexpanding member through the artery to the site; moving said expandingmember between a first configuration wherein said dispensers arepositioned substantially adjacent said axis of said expanding member,and a second configuration wherein said dispensers are radially extendedfrom said axis for penetrating into the media layer of the arterialwall; and releasing said fluid medicament through said dispensers intothe target layer of the arterial wall for a substantiallycircumferential dispersion of said fluid medicament through said medialayer of said wall around the lumen of the artery.
 21. The method ofclaim 20 wherein said fluid medicament inhibits the proliferation ofsmooth tissue growth in the vessel.
 22. The method of claim 20 whereinsaid fluid medicament comprises a radioactive isotope.
 23. The method ofclaim 20 wherein said fluid medicament stimulates the production ofcollateral vessels.
 24. The method of claim 20 wherein said fluidmedicament comprises ^(99m)Tc (Technetium 99).
 25. The method of claim20 wherein said fluid medicament partly precipitates at approximately avessel pH level of the vessel.
 26. The method of claim 20 wherein saidfluid medicament comprises a binder which binds to at least a portion ofthe vessel wall.
 27. The method of claim 20 wherein said fluidmedicament comprises ³²P(Phosphorous 32).
 28. The method of claim 20wherein said fluid medicament comprises a gene for gene therapy.